Friday 2 December 2011

Good A1c, Good A1c, Where Art Thou Good A1c?

Today was DEC day for Dylan. Every 3 months he goes to the Diabetes Education Centre in our local hospital and meets with a team of diabetes specialists, including his pediatric endocrinologist, a dietician, and a diabetes educator/nurse (see It's Not About the Numbers for more details). A1c testing is part of the visit. His last appointment was late July (yes, we're a bit overdue) and his A1c was 7.8. The previous one (in April) had been 8.2, so I was relieved to see it going down in July, though was hoping this time it would be lower again.

My daughter has been home from school the past two days with a stomach bug, so Dylan's dad took him to his appointment this morning. I wasn't happy about missing it, but Dylan is very good about providing me with all of the details, so off he went.

His numbers have not been good lately. He hasn't had a lot of big swings, but he's been running on the high side pretty much non-stop. Not very high, but high enough to contribute to a crappy A1c. Why has he been high? It could be any number of factors, or a combination thereof. He's grown a lot over the past few months and I don't think we've adjusted his pump setting enough to account for his increased  weight. We're still juggling the hockey and pumping issue (see Diabetes on the Ice). His schedule is insanely busy this year, which affects his daily routine, sleep, stress levels, and, therefore, blood sugar levels. He eyeballs carb counts when he's on his own, and while he's pretty good at it, he's not perfect. I tend to let him run a bit high before bed and at night because he is prone to hypoglycemic seizures while sleeping. But the biggest reason he's been running high is because of lack of testing. He's very good about testing when he's at home (read: when I'm there to remind him), but he's been slacking on it at school. Some days he doesn't test at school at all, unless he feels low. That means he eats a recess snack at 10:30am and lunch at noon and inputs nothing into his pump, thus receiving no insulin. Then at 3:15pm, when he gets home, we begin the battle of getting the sugar level down to normal. Repeat every day and you can start to see why the crappy A1c readings.

So while I had prepped myself for the inevitable bad news that I knew we would receive today, I was not expecting  it to be quite as brutal as it was. Today's A1c was 8.7!! That's up almost a full number from July, and is the highest it's been in over a year.

I know it's just a number, but I cannot help but take this one personally. Dylan is only 11 and while he is very independent and responsible with his diabetes, he is a child. I need to step up and do better. Period.

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